1851467823 NPI number — COSTPLUS PHARMACY

Table of content: PATREECE APPLEWHITE (NPI 1235860735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851467823 NPI number — COSTPLUS PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COSTPLUS PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851467823
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104A W UNIVERSITY PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38305-1635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-661-0333
Provider Business Mailing Address Fax Number:
731-661-0343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104A W UNIVERSITY PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38305-1635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-661-0333
Provider Business Practice Location Address Fax Number:
731-661-0343
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
CLAUDIA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
731-661-0333

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4432225 . This is a "NABP" identifier . This identifiers is of the category "OTHER".




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